Healthcare Provider Details

I. General information

NPI: 1134538697
Provider Name (Legal Business Name): JESSICA ECHEVERRIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2014
Last Update Date: 07/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3870 ROSIN CT STE 130
SACRAMENTO CA
95834-1647
US

IV. Provider business mailing address

10060 CAPETOWN LN
STOCKTON CA
95219-7254
US

V. Phone/Fax

Practice location:
  • Phone: 916-441-0226
  • Fax: 916-441-0286
Mailing address:
  • Phone: 209-670-7605
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number89915
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: